025 Triathlon Knee System Surgical Technique

Triathlon
Knee System
Surgical Protocol
Posterior Stabilized
& Cruciate Retaining
Triathlon Knee System
Surgical Protocol
Table of Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
System Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Assembly Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Femoral Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Femoral Intramedullary Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Distal Femoral Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Femoral Sizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Femoral Anterior, Posterior, and Chamfer Resections . . . . . . . . . . . . . . . . . . . . .25
PS Box Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Femoral Trial Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Tibial Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Option 1 - Extramedullary Referencing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Flexion/Extension Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Rotational Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Varus/Valgus Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Tibial Slope Adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Option 2 - Intramedullary Referencing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Rotational Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Varus/Valgus Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Establish Tibial Resection Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Tibial Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Flexion and Extension Gaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Tibial Component Sizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Tibial Trial Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Tibial Keel Punching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Patella Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Option 1 - Bone Removing Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Option 2 - Bone Remaining Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Patella Trial Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Component Implantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
PS or CR Femoral Component . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Primary Tibial Baseplate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
PS or CR Tibial Insert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Symmetric or Asymmetric Patella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Catalog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Surgical Protocol
Acknowledgments
Stryker Orthopaedics wishes to thank the global Triathlon Knee System Surgeon
Panel for their dedication to the development of the Triathlon Knee System.
Introduction
The Triathlon Knee System Instrumentation has been developed based on
Stryker’s 30-year orthopaedic history. The system combines the expertise
of orthopaedic and human factors engineers with that of surgeons and OR staff
worldwide. The Triathlon Knee System Instrumentation provides OR efficiency
and intra-operative flexibility through Orthonomic designs.
Orthonomic Features: Incorporation of ergonomic

principles into the design of orthopaedic instruments
Efficiency
The Triathlon Knee System Instrumentation design team focused on identifying ways
to increase the accuracy and simplicity of the surgical procedure, which are two
variables that may affect OR efficiency. The features incorporated include:
> Open design cutting blocks to enhance visualization,

> Bold markings and color coding for ease of use and clear
identification,
> Quick attach and release mechanisms to facilitate easy assembly,
> A logically organized tray layout based on the operational
sequence for a streamlined process.
Flexibility
The proprietary instrumentation design also delivers intra-operative flexibility.
The following features help surgeons adapt to multiple surgical realities and surgical
preferences:
> Modular cutting captures, handles and cases facilitate customized

surgical flow,
> A common platform that allows for seamless transition through the
indications continuum,
> Navigation ready,
> Minimal incision capability.
Orthonomic Design
The Triathlon Knee System Instrumentation is designed to become the new gold
standard in the industry. Advanced design principles incorporating Orthonomic
features include:
> Ergonomic soft grip handles for optimized surgeon hand fit and comfort,
> Instrument surface enhancements for reduced glare,
> Procedural enhancing mechanisms,
> Lightweight trays for ease of handling.
1
Surgical Protocol
System Highlights Femoral
Femoral Alignment
Alignment &
1 Distal
Distal Resection
Resection
&
2 Femoral
Femoral Sizing
Sizing
3 Femoral
Femoral Bone
Bone Resections
Resections
4 PSPS Box
Box Preparation
Preparation
Tibial
Tibial EM
EM Alignment
Alignment &
5A Resection
Resection
& Tibial
Tibial IM
IM Alignment
5B Resection
Resection
Alignment &
&
6 Tibial Sizing
7 Tibial Keel Preparation
Patella Resection -
Patella Resection -
8A Bone Removing Method 8B Bone Remaining Method
9 Trialing
10 Component Implantation
Surgical Protocol
System Highlights
A Triathlon Knee System

Instrumentation Highlights
pullout has been included.
This can be torn out and used
as a quick reference wall chart
in the OR to aid both the
surgeon and the OR staff.
Assembly Instructions
Instructions
Assembly
Many of the Triathlon Knee System Instruments have unique mechanisms
incorporated to assist surgeons and OR staff, in a simplified, efficient surgical
experience. Therefore, assembly instructions have been included in the first section
of this surgical technique to assist with instruments that may be pre-assembled on
the back table, as well as other instruments that need to be assembled.
All of the mechanisms that allow instruments to be adjusted and/or assembled have
been color-coded. Those that correspond to femoral preparation are black, those for
tibial preparation are bronze and those for patella preparation are gold.
Black Bronze Gold
The surgical technique can be found in the next section beginning on page 17.
Distal Resection Guide, Adjustment Block and

Femoral Alignment Guide Assembly:
> Attach the Distal Resection Guide to the Adjustment

Block by squeezing the black tabs on Adjustment
Block and sliding into the Distal Resection Guide.
> Release the black tabs and ensure that the Distal
Resection Guide is securely snapped into place.
Assembly 1A
> Insert the two posts of the Adjustment Block into the
holes on the Femoral Alignment Guide (for use on
the left or right side). Ensure that the black button
on the Adjustment Block is aligned with the black
knob on the Femoral Alignment Guide.
Assembly 1B
6
Surgical Protocol
Universal Alignment Handle, Distal Resection

Guide and Universal Alignment Rod Assembly:
> Insert the Universal Alignment Handle into the Distal

Resection Guide as shown.
Assembly 2A
> Insert the Universal Alignment Rod as shown.
Assembly 2B
7
Instructions
Femoral Sizer, Femoral Stylus and Modular
Assembly
Handle Assembly:
> Attach the Femoral Stylus to the appropriate

lateral hole of the Femoral Sizer by squeezing the
black tab and inserting into the hole. Release the tab
to lock into place.
> Press the black button on the Modular Handle

and insert into the holes shown. Release the black
button and turn the Modular Handle until it
clicks into place.
Assembly 3
4:1 Cutting Block, Modular Handle, 4:1 Strike

Plate and 4:1 Modular Capture Assembly:
> Insert the 4:1 Strike Plate into the anterior chamfer of
the 4:1 Cutting Block until it clicks into place.
> Press the black button on the Modular Handle

and insert it into the hole shown. Release the black
button and turn the Modular Handle until it clicks
into place.
Assembly 4A
> To attach the 4:1 Modular Capture, turn the black

“bow-tie” knob and cam to disengage the magnet
from the capture surface.
> Attach the 4:1 Modular Capture to the anterior or

posterior resection surfaces by positioning it to
straddle the central web.
> Once fully seated, turn the “bow-tie” knob to engage

the magnet with the captured surface.
Assembly 4B
8
Surgical Protocol
Femoral Impactor Extractor, Impaction Handle

and Femoral Trial or Femoral Component
Assembly:
> Snap the Femoral Impactor Extractor into the

Impaction Handle.
> Ensure the hexagon on the Femoral Impactor

Extractor is fully seated in the Impaction Handle.
When fully seated, there will be an audible snap.
Assembly 5A
> Turn the Impaction Handle counterclockwise until

there is enough space (approximately 10mm)
between the black impaction surface and the ends of
the jaws to insert the Femoral Trial or Femoral
Component.
> Pull back on the mechanism to open the jaws.

Engage the jaws into the impaction slots on the
Femoral Trial or Femoral Component.
> Turn the Impaction Handle clockwise to tighten,

ensuring the impaction surface locks against the
distal condyles of the Femoral Trial or Femoral
Component.
Assembly 5B
> Final Assembly
Assembly 5C
9
Instructions
Tibial Alignment Ankle Clamp EM, Tibial
Assembly
Alignment Distal Assembly EM, Tibial Alignment
Proximal Rod EM, Tibial Stylus, Tibial Resection
Guide Modular Capture and Tibial Adjustment
Housing Assembly:
Note: The Tibial Adjustment Housing is

available in 0° slope (posterior stabilized) and 3°
slope (cruciate retaining):
> Press the bronze button on the Distal Assembly and

slide into the grooves on the Ankle Clamp. Ensure
that the “proximal” side of the Ankle Clamp is
showing (See Inset).
Assembly 6A
> Press the bronze wheel on the Tibial Adjustment

Housing with your thumb and insert the
Proximal Rod. Ensure that the two fixation pins on
the superior portion of the Proximal Rod (See Inset)
are facing posteriorly.
Assembly 6B
> Slide the Proximal Rod until the Tibial Adjustment

Housing engages the teeth on the Proximal Rod.
> Release the bronze wheel to lock into place.
Assembly 6C
10
Surgical Protocol
> Ensure that the bronze lock on the Distal Assembly is

unlocked prior to insertion.
> Insert the Proximal Rod and Tibial Adjustment

Housing assembly into the hole on the top of the
Distal Assembly with the fixation pins on the superior
portion of the Proximal Rod facing posteriorly.
Assembly 6D
> Squeeze the bronze tabs on the Tibial Adjustment

Housing and insert the entire assembly into the
Tibial Resection Guide.
> Release the bronze tabs and ensure that the Tibial
Resection Guide is locked in place.
Assembly 6E
> Squeeze the bronze tab on the Tibial Stylus and

insert the post into the appropriate side of the Tibial
Resection Guide.
> Release the bronze tab to lock the Tibial Stylus

in place.
Assembly 6F
11
Instructions
> Final Assembly
Assembly
Assembly 6G
> Squeeze the bronze tab on the Tibial Resection Guide

Modular Capture to attach it to the Tibial Resection
Guide. Locate the posts on the bottom of the Tibial
Resection Guide Modular Capture and the post holes
on the top surface of the Tibial Resection Guide.
> Insert the posts into the Tibial Resection Guide holes
and slide the Tibial Resection Guide Modular
Capture into place.
> Release the bronze tab to lock the Tibial Resection

Guide Modular Capture into the Tibial Resection
Guide.
Assembly 6H
> Final Assembly
Assembly 6I
12
Surgical Protocol
Universal Tibial Template, Alignment Handle

and PS or CR Tibial Insert Trial Assembly:
> Posterior hole and Channel of Universal Tibial

Template (referenced in Assembly 7B).
Assembly 7A
> Depress and hold the lever on the anterior position

of the Alignment Handle. Insert the spring-loaded
tip of the Alignment Handle into the central
posterior hole of the Universal Tibial Template.
Hold the handle at a slight angle to the top surface of
the template.
> Compress the spring-loaded tip by pushing it

forward and lower the Alignment Handle into the
channel on the anterior portion of the Universal
Tibial Template. Release the spring tension and
allow the Alignment Handle to engage the Universal
Tibial Template.
> Release the lever to secure the assembly.

Assembly 7B
> Position a PS or CR Tibial Insert Trial to the

Universal Tibial Template by first positioning it
posteriorly, at a 20-30º angle to the template and
then fully seat it anteriorly.
Assembly 7C
13
Instructions
Universal Tibial Template and Keel Punch
Assembly
Guide Assembly:
> Ensure that the handle of the Keel Punch Guide is

unlocked – pull back on the handle to unlock.
> Assemble the Keel Punch Guide to the Universal

Tibial Template by inserting the Keel Punch Guide
(at a slight angle to the Universal Tibial Template)
into the two locating slots towards the posterior
portion of the Universal Tibial Template.
Assembly 8A
> Allow the Keel Punch Guide to sit flat on the

Universal Tibial Template and push forward on the
handle of the Keel Punch Guide to lock it to the
Universal Tibial Template.
Assembly 8B
> Final Assembly
Assembly 8C
14
Surgical Protocol
Patella Clamp, Patella Stylus and Patella Clamp

Jaws Assembly (this may also be used to assemble
the Patella Clamp Base, Patella Drill Template
and Patella Cement Cap to the Patella Clamp):
> Snap the Patella Clamp Jaws into the holes on the
Patella Clamp.
Assembly 9A
> Squeeze the gold tab on the Patella Stylus and insert
the post into the hole on either jaw. Use the holes
on the top surface of the jaws if using the Bone
Removing Method or on the bottom surface if using
the Bone Remaining Method.
> The top surface has circular holes, which allow

the stylus to rotate, and the bottom surface has
hex shaped holes fixing the stylus in the center
of the patella.
> Release the gold tab to lock the Patella Stylus in place.
Assembly 9B
15
Instructions
1/8" Hex Drive, Slip Torque Handle and Modular
Assembly
Femoral Distal Fixation Pegs Assembly:
> Snap the 1/8" Hex Drive into the Slip Torque Handle.
Assembly 10A
> Insert the tip of the 1/8" Hex Drive into the
Modular Femoral Distal Fixation Peg and turn the
Slip Torque Handle to tighten.
Assembly 10B
16
Surgical Protocol
Exposure
> A standard anterior midline incision is utilized.
Any previous incision can be used or incorporated to
decrease the risk of skin slough.
> The capsule is entered through a medial parapatellar

approach approximately 1cm from the medial border
of the patella.
> Use a soft tissue approach that allows adequate

patella visualization and sufficient knee flexion.
Figure 1
Femoral Preparation
Femoral Intramedullary Alignment
> The Universal Driver allows for attachment of all
drills and pins. The Universal Driver may be
attached directly to a reamer, drill, or a Jacob’s
Chuck.
> Locate the IM drill hole. It is approximately 1cm

anterior to the femoral attachment of the posterior
cruciate ligament and slightly medial to the midline
of the distal femur.
> Identification of landmarks may be aided by removal

of osteophytes from the margins of the intercondylar
notch.
Figure 2
> Attach the 3/8" IM Drill to the Universal Driver and
drill into the IM canal. The first diameter will create
a tight fit around the IM Rod. If further clearance is
desired, continue to drill until the larger step
diameter opens the hole. This will allow the IM canal
to dictate the position of the rod and avoids the need
to “toggle” the drill to create clearance.
> Attach the T-Handle Driver to the 5/16" IM Rod.

Insert the IM Rod into the Femoral Alignment
Guide. The Femoral Alignment Guide is designed for
use on either the left or right knee and may be set to
5, 6 or 7º of valgus. Set the instrument to the desired
angle by pulling back on the black knob of the
Femoral Alignment Guide and placing it in the
appropriate notch. Advance the rod, with attached
Figure 3 guide, slowly up the IM canal until the desired depth
is reached.
17
Instrument Bar
6541-4-801
Universal Driver
6541-4-538
3/8" IM Drill
Preparation
Femoral
6541-4-800
T-Handle Driver
6541-4-516
5/16" IM Rod
Figure 4
6541-1-657
> Snap the Distal Resection Guide onto the Adjustment Block and Femoral Alignment Guide
insert the posts of the Adjustment Block into the two holes in
the Femoral Alignment Guide (See Assembly 1).
> Place the Femoral Alignment Guide in contact with the more
6541-1-721
prominent distal femoral condyle and align the guide in neutral
Distal Resection Guide
rotation. Although the posterior condyles and the epicondyles
may be used as landmarks for rotation, determining I/E rotation
is not necessary at this time.
> Impact the distal captured pins in the Femoral Alignment Guide
to aid in stabilization. 6541-1-600
Adjustment Block
18
Surgical Protocol
> The Adjustment Block allows for a 8mm (the distal

thickness of the femoral component) and 10mm
(used to aid in the correction of a flexion contracture)
resection level.
> Press the black button on the end of the Adjustment

Block and pull to set the resection to the desired level.
Figure 5
> The Triathlon Knee System Instruments allow for a

clear view of the bone that is being resected to ensure
the appropriate level is set.
> Slide the Adjustment Block Assembly within the

Femoral Alignment Guide until the Distal Resection
Guide contacts the anterior surface of the femur.
Figure 6
19
Instrument Bar
6541-1-600
Adjustment Block
Preparation
Femoral
6541-1-657
Femoral Alignment Guide
6541-1-721
6541-4-806
Universal Alignment Handle
6541-4-602
Universal Alignment Rods
Figure 7
> Prior to pinning the Distal Resection Guide to the femur, an

optional external alignment check may be performed. Attach the
Universal Alignment Handle to the Distal Resection Guide and
insert a Universal Alignment Rod into the handle
(See Assembly 2).
> Alignment is correct when the rod intersects the center of the
femoral head and roughly parallels the axis of the femur in the
lateral view.
20
Surgical Protocol
> Once alignment is confirmed, remove the Universal

Alignment Handle and the Universal Alignment Rod.
> Pin the Distal Resection Guide to the anterior femur

using Headless Pins. Insert the pins into the Headless
Pin Driver (which is inserted into the Universal
Driver) and drill through the set of holes marked “0”
on the Distal Resection Guide. The pins are auto-
matically released from the driver as it is pulled back.
Note: If the medial “0” pin hole is too close to the edge
of the bone (on smaller femurs), use the holes marked
“2” which are closer to the center of the bone.
Note: Ensure that 1/2" of the pin is protruding from all

guides after insertion. This will aid in pin removal.
Figure 8
> After the Distal Resection Guide is pinned

in place, remove the IM rod. The Femoral Alignment
Guide and the Adjustment Block may be removed by
squeezing the black tabs on the Adjustment Block.
> Pinning through the “X” pin-hole will aid in further

securing the guide.
Note: If the “X” pin-hole is used, the pin must be

removed prior to repositioning or removing the Distal
Resection Guide.
Figure 9
Distal Femoral Resection

> The distal resection level may be altered by
repositioning the Distal Resection Guide in either the
2 or 4 holes. This will remove an additional 2mm or
4mm of bone, respectively.
> Once the final resection level is determined, the

distal femoral resection is made. An optional
Modular Capture - Distal Resection may be attached
to the Distal Resection Guide. Squeeze the black tabs
on the Modular Capture - Distal Resection to insert
into the Distal Resection Guide.
> The Triathlon Knee System Instruments are designed

to provide control of the saw blade during bone
resections. When using Modular Captures or cutting
through slots, a .050" (1.25mm) blade is used.
Figure 10
21
Instrument Bar
6541-1-721
6541-4-003
Headless Pins - 3"
Preparation
6541-4-809
Femoral
Headless Pin Driver
6541-4-801
Universal Driver
Figure 11
6541-4-400
Bladerunner
> Remove the Headless Pins by placing the Headless Pin Extractor
over the pin and place it flush on the Distal Resection Guide.
Squeeze the handle approximately four times, ensuring that after
each squeeze, the Headless Pin Extractor is placed flush with the 6541-1-723
Distal Resection Guide. This will allow the tongue on the Modular Capture - Distal Resection
Headless Pin Extractor to back out the pin.
> Remove the Distal Resection Guide and check the resection
for flatness.
6541-4-804
Headless Pin Extractor
22
Surgical Protocol
Femoral Sizing
> Assemble the Femoral Sizer with the Femoral Stylus
in the appropriate lateral hole, setting the stylus
length to an approximate size. Set the rotation to
“LEFT” for a left leg and “RIGHT” for a right leg.
This setting equals 3º of external rotation
(See Assembly 3).
> A secondary rotational check can be made by lining

up the epicondyles with the reference lines marked
“EPI”. A tertiary check is to assess Whiteside’s line
with the Bladerunner through the slot in the top of
the guide.
> Optional Modular Handles may be assembled to the

Figure 12 Femoral Sizer to assist in stabilization
(See Assembly 3).
> In the event of Hypoplasia:

Pin the Femoral Sizer through the hole on the
unaffected side for stability. Rotate the Femoral Sizer
and assess rotation using the rotational checks
mentioned above.
> Position the assembly flush on the resected distal

femur, sliding the feet of the Femoral Sizer under the
posterior condyles. The Femoral Stylus point should
be placed on the lateral cortex.
> It is important that the Femoral Stylus point rest on

bone and not soft tissue.
> The Femoral Sizer may be pinned in place through

Figure 13 the holes marked “X” with Headless Pins.
> The size is determined by the position of the scribe

mark on the Femoral Stylus shaft within the sizing
window.
Figure 14
23
Instrument Bar
6541-1-603
Femoral Sizer
Preparation
Femoral
6541-1-605
Femoral Stylus
6541-4-400
Bladerunner
Figure 15
6541-4-003
Headless Pins - 3"
> It is recommended that the anterior resection level be checked

to further confirm the correct size by sliding a Bladerunner 6541-4-809
through the sizing guide’s size-specific anterior slots and Headless Pin Driver
assessing the resection.
6541-4-801
Universal Driver
6541-4-518
1/8" Peg Drill
Figure 16
> Once size confirmation is complete, attach the 1/8" Peg Drill
to the Universal Driver and create fixation pin-holes (for the
4:1 Cutting Block) through the holes on the face of the
Femoral Sizer marked “EPI”.
24
Surgical Protocol
> Remove the Headless Pins using the Headless Pin

Extractor.
> As a secondary sizing check, use the Bladerunner to

check the M/L width of the Femoral component.
> Line the Bladerunner up with the epicondyles and

determine the component size. Ensure that the notch
of the Bladerunner is on the outside of the femur.
The Bladerunner scribe marks correspond to
component sizes 1 through 8. If the M/L width is
between sizes, the 4:1 Cutting Block can be down-
sized if needed.
Note: For accurate size determination, ensure that all

osteophytes on the medial and lateral condyles are
Figure 17 removed prior to sizing.
Femoral Anterior, Posterior, and

Chamfer Resections
> Locate the fixation pegs of the appropriate size
4:1 Cutting Block into the pin holes created on the
distal femur.
> Attach the 4:1 Strike Plate to the 4:1 Cutting Block
(See Assembly 4A).
Figure 18
> Impact the 4:1 Strike Plate until the 4:1 Cutting Block
is seated flush onto the distal femur.
Note: Do not impact the 4:1 Cutting Block without the

4:1 Strike Plate in place.
Figure 19
25
Instrument Bar
6541-4-003
Headless Pins - 3"
6541-4-809
Headless Pin Driver
6541-4-801
Preparation
Universal Driver
Femoral
6541-4-804
Figure 20
6541-4-400
Bladerunner
> Remove the 4:1 Strike Plate from the 4:1 Cutting Block.
# 1 - 6541-1-701
# 2 - 6541-1-702
# 3 - 6541-1-703
# 4 - 6541-1-704
# 5 - 6541-1-705
# 6 - 6541-1-706
# 7 - 6541-1-707
# 8 - 6541-1-708
4:1 Cutting Block
6541-1-805
4:1 Strike Plate
6541-4-808
Modular Handle
Figure 21
> Modular handles may be assembled to the 4:1 Cutting Block to

aid in both stabilization and removal. Headless Pins may be
utilized for further stabilization (See Assembly 4A).
26
Surgical Protocol
> Complete the remaining four femoral bone

resections.
> The use of a .050" (1.25mm) thick saw blade is

recommended.
> The order of bone resections is not critical; however,

a recommended sequence for improved stability of
the 4:1 Cutting Block is:
> 1. Anterior cortex. The 4:1 Modular Capture may be

added for the anterior resection (See Assembly 4B).
Note: Check run-out of the anterior cut. If there is a
pronounced positive step, consider selecting the next
smaller size 4:1 Cutting Block if the anterior femur
Figure 22 preparation is not adequate.
> 2. Posterior condyles. A Modular Capture may be

added for the posterior resection (See Assembly 4B).
Figure 23
> 3. Posterior chamfer through the permanent capture

on the 4:1 Cutting Block.
Figure 24
27
Instrument Bar
# 1 - 6541-1-701
# 2 - 6541-1-702
# 3 - 6541-1-703
# 4 - 6541-1-704
# 5 - 6541-1-705
# 6 - 6541-1-706
# 7 - 6541-1-707
# 8 - 6541-1-708
4:1 Cutting Block
Preparation
Femoral
6541-1-806
4:1 Modular Capture
Figure 25
> 4. Anterior chamfer through the permanent capture on the

4:1 Cutting Block.
> When performing the anterior chamfer resection, the saw

blade should be passed over the midline of the femur so that the
center portion of bone is resected.
> Care should be taken not to bias the blade while resecting the
bone, as it will cause excess friction between the blade and the
4:1 Cutting Block.
28
Surgical Protocol
> Remove the 4:1 Cutting Block.
> If preparing for a Cruciate Retaining Knee where no

PS box preparation is needed, proceed to Femoral
Trial Assessment on page 32.
PS Box Preparation
> If it is determined that a PS component will be used,
the box must be prepared on the distal femur.
> Place the appropriate size (universal left or right)

PS Box Cutting Guide on the resected distal femur.
Figure 26 With the exception of the anterior geometry the
guide matches the periphery of the corresponding
implant. The anterolateral border of the PS Box
Cutting Guide represents the actual lateral periphery
of the implant (either left or right). On the
anteromedial side of the PS Box Cutting Guide, an
engraved line represents the corresponding medial
curvature of the left or right component (inset).
M/L placement of the guide is based primarily on
best coverage of the distal bone and alignment of the
box opening with the intercondylar notch.
The lateral anterior periphery and medial engraved
line may also be used as references.
> Pin the PS Box Cutting Guide using Headless Pins in

the holes on the anterior surface of the PS Box
Cutting Guide.
> Additional Headless Pins can be placed in the distal

pin holes if additional fixation is required.
Figure 27
The PS box preparation sequence is as follows:

> Cut the cortical rim on both sides of the posterior
most portion of the intercondylar notch using the
oscillating saw.
Figure 28
29
Instrument Bar
# 1 - 6541-1-711
# 2 - 6541-1-712
# 3 - 6541-1-713
# 4 - 6541-1-714
# 5 - 6541-1-715
# 6 - 6541-1-716
# 7 - 6541-1-717
# 8 - 6541-1-718
PS Box Cutting Guide
Preparation
6541-4-003
Femoral
Headless Pins - 3"
6541-4-809
Headless Pin Driver
Figure 29
6541-4-810
Impaction Handle
> Insert the Box Chisel into the Impaction Handle by pressing the
button on the Impaction Handle and snapping the Box Chisel in
place. Insert this assembly into the slot and impact until seated 6541-4-801
to the stop. Care should be taken to visualize posterior soft Universal Driver
tissue structures, which should be retracted from the path of the
chisel. The surface marked "DISTAL" on the Box Chisel should
be oriented as shown. 6541-4-709
Box Chisel
6541-4-803
Slap Hammer
Figure 30
> Leave the Box Chisel in place to act as a backstop when cutting
the medial and lateral edges of the box. Avoid biasing the blade
during resection for optimal bone conservation.
30
Surgical Protocol
> Attach the Slap Hammer to the Box Chisel. Remove

the Box Chisel from the PS Box Cutting Guide and
remove the bone.
Figure 31
> If Modular Femoral Distal Fixation Pegs are to be

used, the location holes may be prepared at this stage
using the 1/4" Peg Drill attached to the Universal
Driver. (The peg holes may also be prepared later
through the PS Femoral Trial).
Figure 32
> Attach the Posterior Osteophyte Removal Tool to the

Impaction Handle and remove the osteophytes
beyond the posterior aspect of the PS Box Cutting
Guide.
> Remove the Headless Pins with the Headless Pin

Extractor.
> Remove the PS Box Cutting Guide using the Slap

Hammer.
Note: If it is difficult to reach the posterior osteophytes

in a tight knee, the tibial resection can be made and
then the osteophytes can more easily be removed.
Figure 33
31
Instrument Bar
6541-4-525
1/4" Peg Drill
6541-4-801
Universal Driver
# 1 - 6541-1-711
# 2 - 6541-1-712
Preparation
# 3 - 6541-1-713
Femoral
# 4 - 6541-1-714
# 5 - 6541-1-715
# 6 - 6541-1-716
# 7 - 6541-1-717
# 8 - 6541-1-718
PS Box Cutting Guide
Figure 34
6541-4-710
Posterior Osteophyte Removal Tool
Femoral Trial Assessment

(The remaining portion of the technique should be used for a
Posterior Stabilized or Cruciate Retaining knee) 6541-4-810
Impaction Handle
> Assemble the appropriate size and side (Left/Right) PS or CR
Femoral Trial to the Femoral Impactor Extractor with the
Impaction Handle (See Assembly 5).
6541-4-804
6541-4-803
Slap Hammer
See Catalog
PS Femoral Trial
See Catalog
Figure 35 CR Femoral Trial
> Impact the PS or CR Femoral Trial onto the prepared distal

femur. Use the Impaction Handle to ensure the Femoral Trial is
6541-4-807
aligned with the distal plane.
Femoral Impactor Extractor
32
Surgical Protocol
> Remove the Femoral Impactor Extractor and

Impaction Handle and assess the fit of the PS or CR
Femoral Trial. Care must be taken to ensure that all
of the osteophytes beyond the end of the posterior
femoral condyles are removed.
• Cruciate Retaining Knee: Attach the 1/4" Peg
Drill to the Universal Driver and create the
Modular Femoral Distal Fixation Peg holes.
Attach the Posterior Osteophyte Removal Tool to
the Impaction Handle and remove posterior
osteophytes.
Note: If it is difficult to reach the posterior condyles in

a tight knee, the tibial resection can be made and then
Figure 36 the osteophytes can more easily be removed.
• Posterior Stabilized Knee: If the Modular

Femoral Distal Fixation Pegs are to be used, and
the holes were not prepared through the PS Box
Cutting Guide, use the 1/4" Peg Drill, attached to
the Universal Driver to prepare the distal femoral
peg holes.
> Attach the Femoral Impactor Extractor to the Slap

Hammer and remove the PS or CR Femoral Trial
from the femur.
Figure 37
33
Instrument Bar
6541-4-525
1/4" Peg Drill
6541-4-801
Universal Driver
6541-4-710
Preparation
Femoral
Posterior Osteophyte Removal Tool
6541-4-810
Impaction Handle
Figure 38
Preparation
Tibial
Tibial Preparation 6541-4-807
> There are two options for tibial preparation: extramedullary
(EM) referencing alignment and intramedullary (IM)
referencing alignment. 6541-4-803
Slap Hammer
> The Tibial Resection Guide, available in Left and Right
configurations, is designed to avoid soft tissue impingement.
Right 6541-2-700
Left 6541-2-701
Tibial Resection Guide
34
Surgical Protocol
Option 1 – Extramedullary Referencing

> The tibial resection assembly has five parts: the
appropriate Tibial Resection Guide, the Ankle Clamp,
the Distal Assembly, the Proximal Rod and the Tibial
Adjustment Housing. These are assembled first
(See Assembly 6).
Note: The Tibial Adjustment Housing is available in
0° slope (posterior stabilized) and 3° slope (cruciate
retaining).
Flexion/Extension Alignment
> The posterior long fixation pin of the Proximal Rod
is partially seated in the proximal tibia to stabilize the
assembly. Place the ankle clamp around the ankle
Figure 39 and unlock the locking switch.
> Flexion/Extension alignment is correct when the long

axis of the assembly parallels the mid-coronal plane
of the tibia. Flexion/Extension alignment can be
checked by verifying that the long axis of the
assembly is parallel to the fibula.
Varus/Valgus Alignment
> Medial/Lateral offset can be adjusted by pushing the
bronze button (1) and sliding the assembly medially
until the shaft intersects the center of the tibia.
> Once triaxial alignment is achieved, release the

bronze button.
Figure 40 Tibial Slope Adjustment

Note: If the Proximal Rod is parallel to the tibia, the
slope is 0° or 3° depending on which Tibial Adjustment
Housing is used.
> Tibial slope can be adjusted by pressing the bronze
button (2).
Rotational Alignment
> Rotate the entire assembly to ensure that the base
of the assembly is aligned with the center of the
ankle. The center of the ankle is generally in line
with the second metatarsal.
> Fix the entire assembly in place by striking the

proximal end of the Proximal Rod with a mallet,
securing the two fixation pins.
Once alignment is confirmed, set the bronze locking

switch on the Distal Assembly to the locked position.
Figure 41
35
Instrument Bar
Right 6541-2-700
Left 6541-2-701
Tibial Resection Guide
6541-2-610
Tibial Alignment Distal Assembly EM
6541-2-609
Tibial Alignment Ankle Clamp EM
Figure 42
Preparation
6541-2-611
Tibial
Tibial Alignment Proximal Rod EM
Option 2 – Intramedullary Referencing

> Attach the 3/8" IM Drill to the Universal Driver and create a hole
in the location determined by the preoperative X-rays. 0º slope 6541-2-704
3º slope 6541-2-705
Tibial Adjustment Housing
6541-4-538
3/8" IM Drill
6541-4-801
Universal Driver
6541-4-800
T-Handle Driver
6541-4-516
5/16" IM Rod
Figure 43
6541-2-600
Tibial Alignment Jig IM
> Attach the T-Handle Driver to the 5/16" IM Rod and slowly pass
into the canal, ensuring clearance. Remove the 5/16" IM Rod and
insert it into the body of the Tibial Alignment Jig IM. The assembly
is then inserted into the canal until the isthmus is engaged.
36
Surgical Protocol
Rotational Alignment
> With the body of the Tibial Alignment Jig IM resting
on the proximal tibia, proper rotational alignment is
achieved by rotating the instrument about the 5/16"
IM Rod so that the vertical mounting bar is over the
medial 1/3 of the tibial tubercle. A Headless Pin or the
1/8" Drill are then inserted into the fixation hole to fix
rotation (See Inset).
Figure 44
Varus/Valgus Alignment
> Assemble the appropriate Tibial Resection Guide
(left or right) and Tibial Adjustment Housing
(See Assembly 6E).
Note: The Tibial Adjustment Housing is available in 0°
slope (posterior stabilized) and 3° slope (cruciate
retaining).
> Attach the assembly onto the mounting bar by
pressing the bronze wheel on the Tibial Adjustment
Housing. Attach the Universal Alignment Handle to
the Tibial Resection Guide and slide a Universal
Alignment Rod through the handle for sagittal
assessment.
> When alignment is confirmed, the Universal
Figure 45 Alignment Handle should be centered over the ankle.
37
Instrument Bar
6541-2-600
Tibial Alignment Jig IM
6541-4-800
T-Handle Driver
6541-4-516
5/16" IM Rod
6541-4-003
Figure 46 Headless Drill-Pins - 3"
Preparation
Tibial
6541-4-809
Headless Pin Driver
[The following applies to both extramedullary and
intramedullary alignment.]
Establish Tibial Resection Level 6541-4-801
> The Tibial Stylus attaches to the Tibial Resection Guide with the “9” Universal Driver
end referencing the lowest level of the unaffected compartment
(See Assembly 6F).
3170-0000
> 9mm of bone will be resected. Alternatively, if the “2”end of the 1/8" Drill
Tibial Stylus is used, the amount of bone resected will be 2mm below
the tip of the stylus.
> The height of the Tibial Resection Guide, Tibial Stylus and Tibial
Adjustment Housing can be adjusted using the bronze wheel on the Right 6541-2-700
Left 6541-2-701
Tibial Adjustment Housing. For coarse adjustment, press the bronze
wheel and slide the assembly up or down. For fine adjustment, turn Tibial Resection Guide
the bronze wheel to the right to move the assembly up the Proximal
Rod or turn left to move the assembly down the Proximal Rod.
> Place two Headless Pins into the “0” [neutral] holes,
fixing the level of the Tibial Resection Guide. 0º slope 6541-2-704
3º slope 6541-2-705
> If additional stability of the guide is required, utilize the oblique “X” Tibial Adjustment Housing
pin-hole.
6541-4-806
Universal Alignment Handle
6541-2-611
Tibial Alignment Proximal Rod EM
6541-4-429
Tibial Stylus
38
Surgical Protocol
> Remove all alignment instruments leaving only the

Tibial Resection Guide in place.
• If Option 1 EM Alignment was used: The Ankle
Clamp, Distal Assembly, Proximal Rod and Tibial
Adjustment Housing are removed. To remove the
assembly, release the bronze lock switch, squeeze
the bronze wheel on the Tibial Adjustment
Housing and lift the lever arm on the Proximal
Rod while holding the wheel release high enough
to clear pins. Squeeze the bronze tabs and remove
the ankle clamp assembly. This will allow the
assembly to disengage from the Tibial Resection
Guide and release the fixation pegs from the
plateau.
Figure 47
• If Option 2 IM Alignment was used: Squeeze the
bronze tabs on the Tibial Adjustment Housing to
disengage the assembly from the Tibial Resection
Guide. Slide the Tibial Adjustment Housing
anteriorly. Remove the 5/16" IM Rod, the Tibial
Alignment Jig IM, the Tibial Adjustment Housing
and the Universal Alignment Handle.
Tibial Resection
> Resection of the proximal tibia is now completed.
An optional Tibial Resection Guide Modular Capture
(Left or Right) may be added (Assembly 6H).
> Remove the Tibial Resection Guide.
Figure 48
Flexion and Extension Gaps

> The flexion gap (90º) and extension gap (0º) may be
assessed using the Adjustable Spacer Block.
The numbers on the thumbwheel correspond to the
implant insert thickness. Lift the Upper Paddle Grip
to free the adjustment wheel. Align the notch with the
appropriate thickness (See Inset) and assess the gap
space until the appropriate insert thickness is
established.
> A Universal Alignment Rod can be placed through

the hole on the Adjustable Spacer Block to check
alignment.
Figure 49
39
Instrument Bar
Right 6541-2-702
Left 6541-2-703
Tibial Resection Guide Modular Capture
6541-4-610
Adjustable Spacer Block
6541-4-602
Figure 50
Preparation
Tibial
See Catalog
PS Femoral Trial
Tibial Component Sizing
> Place the PS or CR Femoral Trial on the femur.
> Sublux the tibia anteriorly. Assemble a Universal Tibial

Template, Alignment Handle and a PS or CR Tibial Insert Trial See Catalog
(See Assembly 7). CR Femoral Trial
> Place the assembly on the resected tibial plateau and choose the
size that best addresses rotation and coverage. # 1 - 6541-1-601
# 2 - 6541-1-602
> Perform a trial reduction to assess overall component fit, # 3 - 6541-1-603
ligament stability and joint range of motion. # 4 - 6541-1-604
# 5 - 6541-1-605
# 6 - 6541-1-606
Note: Ensure all excess debris (bone and soft tissue) is cleared # 7 - 6541-1-607
from the Universal Tibial Template. # 8 - 6541-1-608
Universal Tibial Template
40
Surgical Protocol
Tibial Trial Assessment

> For an optional tibial alignment check, insert a
Universal Alignment Rod into the most anterior hole
of the Alignment Handle and check alignment.
Figure 51
> Place the knee in full extension and assess overall

alignment in the A/P and M/L planes.
> A 1/8" drill can be inserted into the lateral hole on the
anterior surface of the Femoral Trial to aid in align-
ment.
Figure 52
41
Instrument Bar
6541-4-602
6541-4-003
Headless Drill-Pins - 3"
6541-4-809
Headless Pin Driver
6541-4-801
Universal Driver
Figure 53 3170-0000
Preparation
1/8" Drill
Tibial
> There are two options to secure the Universal Tibial Template
to the tibia:
• Option 1: Once satisfactory alignment and tibial
component orientation are achieved, remove the PS or CR
Femoral Trial. Place two Headless Pins in the anterior holes
of the Universal Tibial Template, disassemble the Tibial Trial
Insert from the Universal Tibial Template, and secure by
pinning.
• Option 2: Once satisfactory alignment and tibial

component orientation are achieved, mark the anterior tibial
cortex in line with the reference marks on the anterior
border of the Universal Tibial Template. Remove the PS or
CR Femoral Trial and disassemble the Tibial Trial Insert
from the Universal Tibial Template. Reposition the
Universal Tibial Template (if required) by aligning the
anterior reference marks on the template with the reference
marks on the anterior cortex. The template is positioned
flush to the anterior tibial cortex. Place two Headless Pins in
the anterior holes to secure the Universal Tibial Template.
42
Surgical Protocol
> If additional fixation is required after either

Option 1 or 2 is used, place up to four Headed Nails
in the holes on the Universal Tibial Template into the
tibial plateau.
> Trials may be reassembled to the pinned template for

any subsequent trial reductions.
Figure 54
Tibial Keel Punching

> Assemble the Keel Punch Guide to the Universal
Tibial Template by inserting at a slight angle to the
top of the Universal Tibial Template (into the two
locating slots toward the posterior portion of the
Universal Tibial Template). Allow the Keel Punch
Guide to sit flat on the Universal Tibial Template and
push forward on the handle to lock the Keel Punch
Guide to the Universal Tibial Template
(See Assembly 8).
Figure 55
> Place the appropriate Keel Punch into the Keel

Punch Guide. Use a mallet to impact the Keel
Punch. Advance the Keel Punch until it seats fully
in the Keel Punch Guide.
Figure 56
43
Instrument Bar
6541-4-515
Headed Nails - 1 1/2"
6541-4-575
Headed Nails - 3/4"
Size 1, 2, 3 - 6541-2-713
Size 4, 5, 6, 7, 8 - 6541-2-748
Keel Punch Guide
Sizes 1, 2, 3 - 6541-2-013
Figure 57 Sizes 4, 5, 6 - 6541-2-046
Preparation
Sizes 7, 8 - 6541-2-078
Tibial
Keel Punch
> To extract the Keel Punch, lift up on the Keel Punch Guide
handle and pull the handle to cantilever the Keel Punch out
of the tibia.
6541-4-804
> Remove the Headless Pins with the Headless Pin Extractor Headless Pin Extractor
and remove the Universal Tibial Template.
44
Surgical Protocol
Patella Preparation
> Determine the total thickness of the patella by using
the Patella Caliper.
> There are two options for the patella preparation:

Bone Removing Method and Bone Remaining
Method.
Figure 58
Option 1 – Bone Removing Method
> Assemble Patella Clamp Jaws to the Patella Clamp.

Attach the Patella Stylus to the circular hole on the top
side of either jaw by squeezing the gold tab
(See Assembly 9).
> The Patella Stylus may swivel in this position to sweep

over the highest portion of the articular surface.
> The Patella Stylus references the articular surface of

the patella in order to determine how much bone to
remove.
> Set the desired resection amount on the Patella Stylus

Figure 59 by pressing the gold button and moving the body of
the Patella Stylus to the resection line.
> Close the Patella Clamp around the patella.
> The resection level should be set to match the

thickness of the appropriate size patella implant.
> Ensure that the Patella Stylus is touching the desired

point(s) on the articular surface of the patella.
> Make resection through one of the resection slots.
45
Instrument Bar
6541-3-602
Patella Caliper
6541-3-702
Small Patella Clamp Jaw Right
6541-3-703
Small Patella Clamp Jaw Left
Figure 60 6541-3-704
Large Patella Clamp Jaw Right
Option 2 – Bone Remaining Method

6541-3-705
Large Patella Clamp Jaw Left
> Assemble Patella Clamp Jaws to the Patella Clamp. Attach the
Patella Stylus to the hex shaped hole on the bottom side of
Preparation
either jaw by squeezing the gold tab (See Assembly 9).
Patella
> The Patella Stylus locks in a position that will ensure the
referencing prongs are pointed toward the clamping area. 6541-3-600
Patella Clamp
> The Patella Stylus determines how much bone will remain.
> Set the desired resection amount on the Patella Stylus by

pressing the gold button and moving the body of the Patella
Stylus to the resection line.
6541-3-601
> Close the Patella Clamp around the patella. Patella Stylus
Note: The resection level should not be set at a value less than
12mm.
46
Surgical Protocol
> Ensure that the Patella Stylus is touching the desired

point(s) on the patella tendon.
> Make resection through one of the resection slots.
Figure 61
(The following applies to both Bone Removing Method

and Bone Remaining Method)
> Disengage the Patella Clamp by pressing the gold
release trigger.
> Press the gold buttons on the Patella Clamp to

remove the Patella Clamp Jaws.
Figure 62
> Assess the size of the patella with a Patella Drill

Template (Symmetric and Asymmetric are available).
> Assemble the desired Patella Drill Template and the

Patella Clamp Base to the Patella Clamp. These are
inserted in the same fashion as the Patella Clamp
Jaws (See Assembly 9). Assemble the Patella Clamp
Base first with the Patella Clamp’s outrigger pointing
superiorly.
> Close the Patella Clamp around the patella so that the
Patella Clamp Base is touching the patella tendon and
the base of the Patella Drill Template is touching the
resected surface of the patella. Align the Patella Drill
Template so that it is horizontal with respect to the
Figure 63 poles of the patella.
47
Instrument Bar
29mm - 6541-3-617
32mm - 6541-3-618
35mm - 6541-3-619
38mm - 6541-3-620
40mm - 6541-3-621
Assymetric Patella Drill Template
27mm - 6541-3-627
29mm - 6541-3-629
31mm - 6541-3-631
33mm - 6541-3-633
36mm - 6541-3-636
39mm - 6541-3-639
Symmetric Patella Drill Template
Figure 64
6541-3-801
> Attach the All-Poly Patella Drill with Stop or Metal-Backed Patella Drill Patella Clamp Base
for cementless metal-backed patella option to the Universal Driver and
drill through each fixation peg hole of the Patella Drill Template.
> Disengage the Patella Clamp by pressing the release trigger. Press the
Preparation
gold buttons on the Patella Clamp to remove the Patella Template.
Patella
6541-3-600
Patella Clamp
6541-3-524
All-Poly Patella Drill w/Stop
6541-3-522
Metal-Backed Patella Drill
6541-4-801
Universal Driver
Figure 65 See Catalog

Symmetric Patella Trial
Patella Trial Assessment

> Remove any residual cartilage and wash away all debris. Place correct See Catalog
size Patella Trial (Symmetric or Asymmetric) onto the prepared patella. Asymmetric Patella Trial
> Replace all Trials and assess patellar tracking by taking the knee through
a ROM. The patella should track normally throughout the ROM
without tendency for tilting or lateral subluxation.
48
Surgical Protocol
Component Implantation
> If needed, prepare the resected bone surfaces using
the Bone File, which is attached to the Impaction
Handle.
Figure 66
PS or CR Femoral Component -
Cemented/Cementless
> Attach the Femoral Impactor Extractor to the
Impaction Handle and attach to the appropriate size
and side Femoral Component (See Assembly 5).
Place the Femoral Component on the femur and
impact it until fully seated.
• Posterior Stabilized Knee: If Modular Femoral
Distal Fixation Pegs are to be used, assemble the
pegs to the Femoral Component using the 1/8"
Hex Drive and the Slip Torque Handle prior to
implantation (See Assembly 10).
Figure 67
> The Femoral Impactor can be attached to the

Impaction Handle to further seat the Femoral
Component onto the prepared femur.
Note: Clear all excess bone cement (Does not apply to
cementless component).
Figure 68
49
Instrument Bar
6541-4-700
Bone File
6541-4-807
6541-4-810
Impaction Handle
See Catalog
PS Femoral Component - Cemented
Figure 69 See Catalog

PS Femoral Component - Cementless
Primary Tibial Baseplate -

See Catalog
Cemented/Cementless
CR Femoral Component - Cemented
> Connect the Tibial Baseplate Impactor Extractor to
the Impaction Handle. To connect this assembly to
the Primary Tibial Baseplate, ensure the locking lever
is in the unlocked position and place the head onto See Catalog
the Primary Tibial Baseplate straddling the central CR Femoral Component - Cementless
island. Ensure the Tibial Baseplate Impactor
Extractor sits flat on the top surface of the Primary 6541-4-802
Tibial Baseplate and move the locking lever to the 1/8" Hex Drive
locked position.
Implantation
Component
> Introduce the Primary Tibial Baseplate onto the 6541-4-825
prepared tibia and impact until the baseplate is Slip Torque Handle
seated. Unlock the locking lever and remove the
assembly from the Primary Tibial Baseplate. See Catalog
Modular Femoral Distal Fixation Pegs
6541-4-811
Femoral Impactor
6541-4-805
Baseplate Impactor/Extractor
See Catalog
Primary Tibial Baseplate - Cemented
See Catalog
Primary Tibial Baseplate - Cementless 50
Surgical Protocol
> To further seat the baseplate, attach the Tibial

Baseplate Impactor to the Impaction Handle.
> Place the Tibial Baseplate Impactor on to the
Primary Tibial Baseplate straddling the central island.
Ensure the Tibial Baseplate Impactor sits flat on the
top surface of the Primary Tibial Baseplate.
> Impact until the Primary Tibial Baseplate is fully
seated.
Note: Clear all excess bone cement while maintaining
position of the Primary Tibial Baseplate.
PS or CR Tibial Insert
Figure 70 > Prior to assembly of the PS or CR Tibial Insert, the
PS or CR Tibial Trial Insert may be placed on the
Primary Tibial Baseplate to once more assess joint
stability and range of motion.
> To assemble the PS or CR Tibial Insert, distract the
joint and angle the insert posteriorly into the Primary
Tibial Baseplate. The posterior lip of the Tibial Insert
must fit beneath the lip on the posterior Primary
Tibial Baseplate wall.
> Attach the Tibial Insert Impactor to the Impaction
Handle and impact to snap the Insert in place
anteriorly. The PS or CR Tibial Insert is fully seated
once the locking wire locks under the barbs on the
anterior/interior surface of the Primary Tibial
Baseplate wall.
Symmetric (All-Poly) or Asymmetric Patella

Figure 71 (All-Poly and Metal-Backed)
> Assemble the Patella Cement Cap and the Patella
Clamp Base to the Patella Clamp (See Assembly 9).
Note: If necessary, use a curette to mark the locations of
the fixation peg holes.
> Place the Patella Component onto the prepared
patella, making certain the fixation peg holes are
aligned to the corresponding holes.
> Seat the Patella Component onto the prepared patella
by clamping the Patella Cement Cap, Patella Clamp
Base and Patella Clamp assembly.
Note: Insure that the silicon o-ring of the Patella
Cement Cap is placed on the articulating surface of the
Patella Component.
Note: Leave the assembly clamped to the patella
while excess cement is cleared and polymerization
is complete.
> Disengage the Patella Clamp by pressing the
Figure 72 gold release trigger.
51
Instrument Bar
6541-4-810
Impaction Handle
6541-4-812
Tibial Baseplate Impactor
6541-4-813
Tibial Insert Impactor
Figure 73
See Catalog
> Assess the joint in flexion and extension. PS Tibial Insert
Closure
For Cemented Components
> After cement polymerization and removal of all residual cement, See Catalog
thoroughly irrigate the joint. Hemostasis is achieved after deflation CR Tibial Insert
of the tourniquet. Close soft tissues in the normal layered fashion.
6541-3-800
Patella Cement Cap
Implantation
Component
6541-3-801
Patella Clamp Base
6541-3-600
Patella Clamp
See Catalog
Symmetric Patella
See Catalog
Asymmetric Patella
See Catalog
Metal-Backed Asymmetric Patella-Beaded w/PA
52
Surgical Protocol
Catalog # Description Quantity in Kit

Miscellaneous Instruments Kit Contents
3170-0000 1/8" Drill 2
6541-4-003 Headless Pins - 3" 4
6541-4-300 Headed Nail Impactor Extractor 1
6541-4-400 Bladerunner 1
6541-4-515 Headed Nails - 1 1/2" 2
6541-4-516 5/16" IM Rod 1
6541-4-518 1/8" Peg Drill 1
6541-4-525 1/4" Peg Drill 1
6541-4-538 3/8" IM Drill 1
6541-4-575 Headed Nails - 3/4" 2
6541-4-602 Universal Alignment Rods 2
6541-4-610 Adjustable Spacer Block 1
6541-4-700 Bone File 1
6541-4-709 Box Chisel 1
6541-4-710 Posterior osteophyte removal tool 1
6541-4-800 T-Handle Driver 1
6541-4-801 Universal Driver 1
6541-4-802 1/8" Hex Drive 1
6541-4-803 Slap Hammer 1
6541-4-804 Headless Pin Extractor 1
6541-4-805 Tibial Baseplate Impactor Extractor 1
6541-4-806 Universal Alignment Handle 1
6541-4-807 Femoral Impactor Extractor 1
6541-4-808 Modular Handle 2
6541-4-809 Headless Pin Driver 1
6541-4-810 Impaction Handle 2
6541-4-811 Femoral Impactor 1
6541-4-812 Tibial Baseplate Impactor 1
6541-4-813 Tibial Insert Impactor 1
6541-4-825 Slip Torque Handle 1
6541-8-004 Triathlon Miscellaneous Upper Tray 1
6541-8-104 Triathlon Miscellaneous Lower Tray 1
6541-9-000 Triathlon Case 1
Total Quantity 42
53
Patella Preparation & Trialing Kit Contents
5550-T-278 Symmetric Patella Trial S27mm x 8mm 1
5551-T-299 Asymmetric Patella Trial A29mm (S/I*) x 9mm 1
6541-3-522 Metal-Backed Patella Drill 1
6541-3-524 All-Poly Patella Drill w/ Stop 1
6541-3-600 Patella Clamp 1
6541-3-601 Patella Stylus 1
6541-3-602 Patella Caliper 1
6541-3-617 Asymmetric Patella Drill Template - A29mm 1
6541-3-627 Symmetric Patella Drill Template - S27mm 1
6541-3-702 Small Patella Clamp Jaw Right 1
6541-3-703 Small Patella Clamp Jaw Left 1
Catalog
6541-3-704 Large Patella Clamp Jaw Right 1
6541-3-705 Large Patella Clamp Jaw Left 1
6541-3-800 Patella Cement Cap 1
6541-3-801 Patella Clamp Base 1
8050-5001L Left Lateral Tibial Retractor 1
8050-5001R Right Lateral Tibial Retractor 1
8050-5002 Anterior Femoral Retractor 1
6541-8-005 Triathlon Patella Upper Tray 1
6541-8-105 Triathlon Patella Lower Tray 1
Total Quantity 39
*S/I = Superior/Inferior
54
Surgical Protocol

Size 3-6 Femoral & Tibial Preparation Kit Contents
6541-1-600 Adjustment Block 1
6541-1-603 Femoral Sizer 1
6541-1-605 Femoral Stylus 1
6541-1-657 Femoral Alignment Guide 1
6541-1-703 #3 4:1 Cutting Block 1
6541-1-704 #4 4:1 Cutting Block 1
6541-1-705 #5 4:1 Cutting Block 1
6541-1-706 #6 4:1 Cutting Block 1
6541-1-721 Distal Resection Guide 1
6541-1-723 Modular Capture - Distal Resection 1
6541-1-805 4:1 Strike Plate 1
6541-1-806 4:1 Modular Capture 2
6541-2-013 Size 1-3 Keel Punch 1
6541-2-429 Tibial Stylus 1
6541-2-600 Tibial Alignment Jig IM 1
6541-2-603 #3 Universal Tibial Template 1
6541-2-609 Tibial Alignment Ankle Clamp EM 1
6541-2-610 Tibial Alignment Distal Assembly EM 1
6541-2-611 Tibial Alignment Proximal Rod EM 1
6541-2-620 Tibial Template Converter 1
6541-2-700 Tibial Resection Guide Right 1
6541-2-701 Tibial Resection Guide Left 1
6541-2-702 Tibial Resection Guide Modular Capture Right 1
6541-2-703 Tibial Resection Guide Modular Capture Left 1
6541-2-704 Tibial Adjustment Housing - 0° slope 1
6541-2-705 Tibial Adjustment Housing - 3° slope 1
6541-2-713 Size 1-3 Keel Punch Guide 1
6541-2-748 Size 4-8 Keel Punch Guide 1
6541-2-807 Tibial Alignment Handle 1
6541-8-002 Triathlon Size 3-6 Upper Tray 1
6541-8-102 Triathlon Size 3-6 Lower Tray 1
Total Quantity 37
55
Size 3-6 PS Femoral & Tibial Trialing Kit Contents
5511-T-301 PS Femoral Trial # 3 Left 1
5511-T-302 PS Femoral Trial # 3 Right 1
5532-T-309 PS Tibial Insert Trial # 3 - 9mm 1
5532-T-619 PS Tibial Insert Trial # 6 - 19mm 1 Catalog
6541-1-713 #3 PS Box Cutting Guide 1
6541-8-009 Triathlon 3-6 PS Upper Tray 1
6541-8-109 Triathlon 3-6 PS Lower Tray 1
Total Quantity 35
*S/I = Superior/Inferior
56
Surgical Protocol

Size 3-6 CR Femoral & Tibial Trialing Kit Contents
5510-T-301 CR Femoral Trial # 3 Left 1
5510-T-302 CR Femoral Trial # 3 Right 1
5530-T-309 CR Tibial Insert Trial # 3 - 9mm 1
6541-8-008 Triathlon 3-6 CR Upper Tray 1
6541-8-108 Triathlon 3-6 CR Lower Tray 1
Total Quantity 31
57
Size 1, 8 PS Preparation & Trialing Kit Contents
6541-1-701 #1 4:1 Cutting Block 1
6541-1-708 #8 4:1 Cutting Block 1
6541-8-113 Triathlon 1 & 8 PS Lower Tray 1
Total Quantity 23
Catalog
58
Surgical Protocol

Size 1, 8 CR Preparation & Trialing Kit Contents
6541-1-701 #1 4:1 Cutting Block 1
6541-1-708 #8 4:1 Cutting Block 1
6541-8-112 Triathlon 1 & 8 CR Lower Tray 1
Total Quantity 21
Size 2, 7 PS Preparation & Trialing Kit Contents

6541-1-702 #2 4:1 Cutting Block 1
6541-1-707 #7 4:1 Cutting Block 1
6541-8-022 Triathlon 2 & 7 PS Upper Tray 1
Total Quantity 23
59
Size 2, 7 CR Preparation & Trialing Kit Contents
6541-1-702 #2 4:1 Cutting Block 1
6541-1-707 #7 4:1 Cutting Block 1
6541-8-021 Triathlon 2 & 7 CR Upper Tray 1
Total Quantity 21
Size 1-8 Max PS Tibial Trialing Kit Contents

Catalog
6541-8-020 Triathlon Max PS Tibial Trialing Upper Tray 1
6541-8-120 Triathlon Max PS Tibial Trialing Lower Tray 1
Total Quantity 19
60
Surgical Protocol
Catalog # Description
PS Femoral Component - Cemented Part Numbers
5515-F-101 PS Femoral Component – Cemented #1 Left
5515-F-102 PS Femoral Component – Cemented #1 Right
CR Femoral Component - Cemented Part Numbers

5510-F-101 CR Femoral Component – Cemented #1 Left
5510-F-102 CR Femoral Component – Cemented #1 Right
Primary Tibial Baseplate - Cemented Part Numbers

5520-B-100 Primary Tibial Baseplate – Cemented #1
61
PS Tibial Insert Part Numbers
5532-P-109* PS Tibial Insert #1 – 9mm
5532-P-209 PS Tibial Insert #2 – 9mm




5532-P-513 PS Tibial Insert #5 – 13mm Catalog

Continued Note: 5532-P-109 through 5532-P-125 are not available for sale in the US.
62
Surgical Protocol
PS Tibial Insert Part Numbers - Continued

PS Tibial Insert - X3 Part Numbers

5532-G-109 PS Tibial Insert - X3 # 1 - 9mm


Continued
63
PS Tibial Insert - X3 Part Numbers - Continued



5532-G-809 PS Tibial Insert - X3 # 8 - 9mm Catalog

64
Surgical Protocol
CR Tibial Insert Part Numbers
5530-P-109 CR Tibial Insert #1 – 9mm







65
CR Tibial Insert - X3 Part Numbers
5530-G-109 CR Tibial Insert - X3 # 1 - 9mm





5530-G-619 CR Tibial Insert - X3 # 6 - 19mm Catalog


66
Surgical Protocol
Symmetric Patella Part Numbers
5550-L-278 Symmetric Patella S27mm x 8mm
Symmetric Patella - X3 Part Numbers

5550-G-278 Symmetric Patella - X3 - S27mm x 8mm
Asymmetric Patella Part Numbers

5551-L-299 Asymmetric Patella A29mm (S/I*) x 9mm
Asymmetric Patella - X3 Part Numbers

5551-G-299 Asymmetric Patella - X3 - A29mm (S/I*) x 9mm
Modular Femoral Distal Fixation Peg Part Number

5575-X-000 Modular Femoral Distal Fixation Peg (2 per pack)
* S/I = Superior/Inferior
67
Catalog # Description Cementless
PS Femoral Cementless Component - Beaded Part Numbers
5514-F-101 PS Femoral Component - Beaded - #1, Left
5514-F-102 PS Femoral Component - Beaded - #1, Right
PS Femoral Cementless Component - Beaded with

Peri-Apatite Part Numbers
5516-F-101 PS Femoral Component - Beaded w/PA - #1, Left
5516-F-102 PS Femoral Component - Beaded w/PA - #1, Right
5516-F-702 PS Femoral Component - Beaded w/PA - #7, Right Catalog
68
Surgical Protocol

CR Femoral Cementless Component - Beaded Part Numbers
5513-F-101 CR Femoral Component - Beaded - #1, Left
5513-F-102 CR Femoral Component - Beaded - #1, Right
CR Femoral Cementless Component - Beaded with

Peri-Apatite Part Numbers
5517-F-101 CR Femoral Component - Beaded w/PA - #1, Left
5517-F-102 CR Femoral Component - Beaded w/PA - #1, Right
69
Primary Tibial Baseplate - Beaded Part Numbers
5523-B-100 Primary Tibial Baseplate - Beaded - #1
Primary Tibial Baseplate - Beaded with Peri-Apatite Part Numbers

5526-B-100 Primary Tibial Baseplate - Beaded w/PA - #1
Asymmetric Metal-Backed Patella - Beaded with Peri-Apatite

Part Numbers
5554-L-320 Asymmetric Metal-Backed Patella-Beaded w/PA-A32mm x 10mm
5554-L-350 Asymmetric Metal-Backed Patella- Beaded w/PA -A35mm x 10mm
Catalog
70
Surgical Protocol
Notes
Notes
Surgical Protocol
Warnings and Precautions • Wear of polyethylene components has occurred and
literature reports have associated its occurrence with
Indications bone resorption, loosening and infection.
General Total Knee Arthroplasty (TKR) Indications • Metal sensitivity reactions have been reported
include: following joint replacement.
• Painful, disabling joint disease of the knee resulting • Adverse effects may necessitate reoperation, revision,
from: non-inflammatory degenerative joint disease arthrodesis of the involved joint, and/or amputation
(including osteoarthritis, traumatic arthritis or of the limb.
avascular necrosis) or rheumatoid arthritis. • Soft tissue imbalance and/or laxity has been related to
• Post-traumatic loss of knee joint configuration and component malalignment, which may result in early
function. wear and/or failure of the implant.
• Moderate varus, valgus, or flexion deformity in which • With all implant devices, asymptomatic, localized
the ligamentous structures can be returned to progressive bone resorption (osteolysis) may occur
adequate function and stability. around the prosthetic components as a consequence
• Revision of previous unsuccessful knee replacement or of foreign-body reaction to the particulate matter of
other procedure. cement, metal, ultra-high molecular weight
• Fracture of the distal femur and/or proximal tibia that polyethylene (UHMWPE) and/or ceramic. Particulate
cannot be stabilized by standard fracture management is generated by interaction between components, as
techniques. well as between components and bone, primarily
through wear mechanisms of adhesion, abrasion and
Contraindications fatigue. Secondarily, particulate can also be generated
• Any active or suspected latent infection in or about the by third-body wear. Osteolysis can lead to future
knee joint. complications, including loosening, necessitating the
• Distant foci of infection which may cause removal and replacement of prosthetic components.
hematogenous spread to the implant site. • It is known that very small particles from metal and
• Any mental or neuromuscular disorder which would polyethylene components can be shed from the
create an unacceptable risk of prosthesis instability, component during normal use and over time.
prosthesis fixation failure, or complications in Although most of this debris stays in the relevant
postoperative care. joint (e.g. contained in the synovium) or is trapped
• Bone stock compromised by disease, infection or prior by surrounding scar tissue, microscopic particles can
implantation which cannot provide adequate support possibly travel or migrate outside of the joint to
and/or fixation to the prosthesis. different parts of the body. Currently, there are
• Skeletal immaturity. unanswered questions about debris and microscopic
• Severe instability of the knee joint secondary to the particles that can be generated from these
absence of collateral ligament integrity and function. components. It has been shown that microscopic
• Obesity. An overweight or obese patient can produce debris particles can be disseminated (migrate)
loads on the prosthesis which can lead to failure of the throughout the body and on occasion have been
fixation of the device or to failure of the device itself. described as accumulating in lymph nodes and other
See package insert for warnings, precautions, adverse parts of the body. Although to date no significant
effects and other essential product information. medical complications have been reported as a result
of these particles, their migration and/or
Adverse Effects accumulation in the body have been described in the
• While the expected life of total knee replacement literature. Given the insufficient time period during
components is difficult to estimate, it is finite. These which patients with these devices have been followed
components are made of foreign materials which are and the fact that these devices are currently being
placed within the body for the potential restoration of used in younger patients and remain in the body for
mobility or reduction of pain. However, due to the increasingly longer periods of time, it should be said
many biological, mechanical and physicochemical that the long-term effects, if any, from these particles,
factors which affect these devices but cannot be is unknown. The long-term effects that have been
evaluated in vivo, the components cannot be expected theorized include:
to indefinitely withstand the activity level and loads of – Cancer: There is presently no scientific evidence
normal healthy bone. Surgeons should counsel that links metallic or polyethylene debris with
patients against having unrealistic expectations about cancer. However, the possibility cannot be ruled out.
the lifetime ofthe device. – Lymphadenopathy and Accumulation in Other
• Dislocation of the femoral, tibial, or patellar prosthesis Tissues/Organs: There have been a few reports of
can occur due to inappropriate patient activity,trauma the accumulation of wear debris in lymph nodes
or other biomechanical considerations. (proximate and distal). Although no medical
• Loosening of total knee components can occur. Early complications or disease process has been reported
mechanical loosening may result from inadequate as stemming from these accumulations, their
initial fixation, latent infection, premature loading of existence should be recognized to facilitate
the prosthesis, component malalignment or trauma. diagnosis and avoid confusion with suspicious
Late loosening may result from trauma, infection, lesions, cancerous or otherwise.
biological complications including osteolysis, or – Systemic Disease: There has been some speculation
mechanical problems, with the subsequent possibility that there could be an association between
of bone erosion and/or pain. migration of debris and as yet unspecified systemic
• Fatigue fracture of total knee components, including effects. No case studies or other reports have been
tibial, femoral and patellar components, has occurred published suggesting any such possibility. Again,
in a small percentage of cases. Knee component given the limited time period during which patients
fracture may result due to inadequate support of the receiving these implants have been followed, it
component by the underlying bone or poor cannot be scientifically proven that some long-term
component fixation. effect may not show up in the future. Given the
• Peripheral neuropathies, nerve damage, circulatory dearth of scientific data suggesting any association
compromise and heterotopic bone formation may is by the use of these materials for several decades, it
occur. is strongly believed that the benefits of these devices
• Serious complications may be associated with any clearly outweigh the potential risks for any such
total joint replacement surgery. These complications theoretical long-term effect.
include, but are not limited to: genitourinary
disorders; gastrointestinal disorders; vascular Patient Counseling
disorders, including thrombus; bronchopulmonary Surgeons should discuss all relevant contraindications,
disorders, including emboli; myocardial infarction or adverse effects and the need for post-implantation
death. protection with their patients.
73
Joint Replacements
Trauma, Extremities & Deformities
Craniomaxillofacial
Spine
Biologics
Surgical Products
Neuro & ENT
Interventional Pain
Navigation
Endoscopy
Communications
Imaging
Patient Handling Equipment
EMS Equipment
325 Corporate Drive

Mahwah, New Jersey 07430
t: 201 831 5000
www.stryker.com
A surgeon must always rely on his or her own professional clinical judgment when deciding to use which
products and/or techniques on individual patients. Stryker is not dispensing medical advice and recommends
that surgeons be trained in orthopaedic surgeries before performing any surgeries.
The information presented in this brochure is intended to demonstrate the breadth of Stryker product offerings.
Always refer to the package insert, product label and/or user instructions before using any Stryker product.
Products may not be available in all markets. Product availability is subject to the regulatory or medical practices
that govern individual markets. Please contact your Stryker representative if you have questions about the
availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the
following trademarks or service marks: Triathlon. All other trademarks are trademarks of their respective
owners or holders.
Literature Number: LSPK42 Rev.1

MS/GS 2m 11/06
Copyright © 2006 Stryker

Printed in USA

025 Triathlon Knee System Surgical Technique

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025 Triathlon Knee System Surgical Technique

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Triathlon

Orthonomic Features: Incorporation of ergonomic

> Open design cutting blocks to enhance visualization,

> Modular cutting captures, handles and cases facilitate customized

7 Tibial Keel Preparation

A Triathlon Knee System

Black Bronze Gold

Distal Resection Guide, Adjustment Block and

> Attach the Distal Resection Guide to the Adjustment

Universal Alignment Handle, Distal Resection

> Insert the Universal Alignment Handle into the Distal

> Insert the Universal Alignment Rod as shown.

> Attach the Femoral Stylus to the appropriate

> Press the black button on the Modular Handle

4:1 Cutting Block, Modular Handle, 4:1 Strike

> Press the black button on the Modular Handle

> To attach the 4:1 Modular Capture, turn the black

> Attach the 4:1 Modular Capture to the anterior or

> Once fully seated, turn the “bow-tie” knob to engage

Femoral Impactor Extractor, Impaction Handle

> Snap the Femoral Impactor Extractor into the

> Ensure the hexagon on the Femoral Impactor

> Turn the Impaction Handle counterclockwise until

> Pull back on the mechanism to open the jaws.

> Turn the Impaction Handle clockwise to tighten,

> Final Assembly

Note: The Tibial Adjustment Housing is

> Press the bronze button on the Distal Assembly and

> Press the bronze wheel on the Tibial Adjustment

> Slide the Proximal Rod until the Tibial Adjustment

> Release the bronze wheel to lock into place.

> Ensure that the bronze lock on the Distal Assembly is

> Insert the Proximal Rod and Tibial Adjustment

> Squeeze the bronze tabs on the Tibial Adjustment

> Squeeze the bronze tab on the Tibial Stylus and

> Release the bronze tab to lock the Tibial Stylus

> Squeeze the bronze tab on the Tibial Resection Guide

> Release the bronze tab to lock the Tibial Resection

> Final Assembly

Universal Tibial Template, Alignment Handle

> Posterior hole and Channel of Universal Tibial

> Depress and hold the lever on the anterior position

> Compress the spring-loaded tip by pushing it

> Release the lever to secure the assembly.

> Position a PS or CR Tibial Insert Trial to the

> Ensure that the handle of the Keel Punch Guide is

> Assemble the Keel Punch Guide to the Universal

> Allow the Keel Punch Guide to sit flat on the

> Final Assembly

Patella Clamp, Patella Stylus and Patella Clamp

> The top surface has circular holes, which allow

> The capsule is entered through a medial parapatellar

> Use a soft tissue approach that allows adequate

> Locate the IM drill hole. It is approximately 1cm

> Identification of landmarks may be aided by removal

> Attach the T-Handle Driver to the 5/16" IM Rod.

> The Adjustment Block allows for a 8mm (the distal

> Press the black button on the end of the Adjustment

> The Triathlon Knee System Instruments allow for a

> Slide the Adjustment Block Assembly within the

> Prior to pinning the Distal Resection Guide to the femur, an

> Once alignment is confirmed, remove the Universal

> Pin the Distal Resection Guide to the anterior femur

Note: Ensure that 1/2" of the pin is protruding from all